Thread by @InfectiousNeo

The surge in #measles and #mumps are newsworthy, hot-topic attention grabbers. However, can I make a quick plug for something that is almost certainly going to be an issue in the near future? 1/x

The declines in MMR #vaccine coverage have led to increased outbreaks, several of which have been close to home (looking at you, #Texas). Therefore, coverage for "R" - rubella - is declining in parallel with measles and mumps in the same zip codes. 2/x

The reproductive number (R0), a measure of how infectious a given pathogen is, is highest for measles, medium for mumps, and lowest for rubella. So rubella will show up last... but it's coming. Good review: ncbi.nlm.nih.gov/pmc/articles/P… 3/x

About half of the affected cases in the New York, Texas, and California outbreaks have been adolescents or young adults. This means that women of childbearing age are increasingly at risk for rubella. 4/x

I have seen countless congenital #CMV babies, countless congenital #syphilis cases, a depressing number of HIV and HSV-infected newborns. I've seen neonatal babesia. Neonatal Chagas. Hepatitis B. Hep C. 5/x

I've never seen congenital rubella. There are 1-2 imported cases annually in the US, but endemic rubella was eliminated*. ncbi.nlm.nih.gov/pmc/articles/P… 6/x

But as vaccine rates fall, we will see it. It's happening already in Europe ncbi.nlm.nih.gov/pmc/articles/P…, and the US has seen at least one "home-grown" case in the last 5 years. ncbi.nlm.nih.gov/pmc/articles/P… 7/x

I have this cover of LIFE magazine from 1965 framed in my office - a pregnant woman getting her blood drawn during the 64-65 #rubella pandemic. Look at her face. WHY would we go back to this??? 8/x

Be vigilant. It's coming, and most of us haven't seen it, but every third-year medical student can rattle off the classic triad of congenital #rubella. Anterior cataracts, sensorineural hearing loss, and cardiac defects. But most will be less overt than that. 9/x

Unless MMR coverage changes, we will see a detectable uptick in congenital rubella cases in the US in the next 3-5 years. We are literally not immune. 10/11

Here is some unfortunately required reading: @CDCgov guidance on surveillance for #rubella. Brush up. Winter is coming. Thanks for reading. 11/11 - FIN.
cdc.gov/vaccines/pubs/…

CC: @PeterHotez @PIDSociety @TXPeds